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India’s human development rankings are struggling to keep up as the country rises through the per capita GDP rankings. At the UCL Lancet Lecture, Professor Jayati Ghosh set out an alternative public health-centred growth strategy to address the deepening divide. Kelly Clarke reports.

The dream
An increase in per capita income increases the amount of money available to spend on food. Governments have access to larger funds for public health programmes to improve basic health facilities, sanitation, education, housing, transport, etc, etc.

The Indian reality
Ghosh, one of the world’s leading economists, described how the Indian government is failing to synergise economic development with an improvement in basic health indicators. The reason: a lack of investment in public health.

At 230 deaths per 100,000 live births, India’s maternal mortality rate compares unfavourably with the Asian average of 162, China’s 38, South Korea’s 18 and Japan’s six. Female infant mortality, 51 per 1,000, remains twice that of Vietnam’s – a country that India is now well above in terms of per capita income.

Per capita food grain consumption has gone down in India over the past two decades while Indian food prices have been rising. It’s not just about food but also sanitation – 69% of the population does not have access to basic services such as clean drinking water and toilets.

The deficit in public health spending is currently made up by out of pocket spending from household budgets on private services.

But if household budgets are increasing so household spending can increase, this prompts the question: “Why does maternal mortality and female infant mortality remain so high?” The answer is that the health and education needs of mothers and daughters are not prioritised by a patriarchal society. India’s women are being left behind.

The solution
Ghosh urged the Indian government to “put your money where your mouth is” and invest in public health. The current growth strategy is inadequate; more money must be spent on health, nutrition and education.

The effect of this will not only be a more productive future workforce, but also employment opportunities for those working in the public health sector. More jobs means more money, more spending and perpetuation of the current economic growth.

Simple. But the million rupee question that, in my mind, remains unanswered by Ghosh’s eloquent and persuasive argument is how do we get this failing government to listen?

Kelly Clarke is a PhD student at the UCL Centre for International Health and Development.